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Optic Perineuritis
Clinical and Radiographic Features
Valerie Purvin, MD;
Aki Kawasaki, MD;
Daniel M. Jacobson, MD
Arch Ophthalmol. 2001;119:1299-1306.
Background Optic perineuritis is an uncommon variety of orbital inflammatory disease
that is distinct from demyelinating optic neuritis.
Objective To describe the clinical and radiographic features of idiopathic optic
perineuritis, with particular emphasis on those features that help to distinguish
this condition from optic neuritis.
Methods We reviewed the medical records of 14 patients with optic perineuritis
who were seen in 2 neuro-ophthalmology clinics.
Results Patients ranged in age from 24 to 60 years; 5 were older than 50 years.
All patients had visual loss, eye pain, or both. The visual acuity was 20/20
or better in 8 of the 15 eyes. The results of visual field testing were normal
in 2 eyes, and a paracentral scotoma or an arcuate defect was seen in 7. Magnetic
resonance imaging scans demonstrated circumferential enhancement around the
optic nerve, sometimes with intraorbital extension. Response to corticosteroids
was dramatic; however, 4 patients had a relapse with lowering of the dose.
Conclusions In contrast to those with optic neuritis, patients with optic perineuritis
are often older at onset and are more likely to show sparing of central vision.
Magnetic resonance imaging scans demonstrate enhancement around, rather than
within, the optic nerve. Response to corticosteroids is more dramatic than
in patients with optic neuritis, and patients are more likely to experience
recurrence after stopping treatment.
From the Midwest Eye Institute and the Departments of Neurology and
Ophthalmology, Indiana University Medical Center, Indianapolis (Drs Purvin
and Kawasaki); and the Marshfield Clinic, Marshfield, Wis (Dr Jacobson).
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Archives of Ophthalmology Reader's Choice: Continuing Medical Education
Arch Ophthalmol. 2001;119(9):1399-1400.
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